Preface to The Surgeon General’s Report on Alcohol, Drugs and Health

Before I assumed my position as U.S. Surgeon General, I stopped by the hospital where I had worked since my residency training to say goodbye to my colleagues. I wanted to thank them, especially the nurses, whose kindness and guidance had helped me on countless occasions. The nurses had one parting request for me. If you can only do one thing as Surgeon General, they said, “Please do something about the addiction crisis in America.”

I have not forgotten their words. As I have traveled across our extraordinary nation, meeting people struggling with substance use disorders and their families, I have come to appreciate even more deeply something I recognized through my own experience in patient care: that substance use disorders represent one of the most pressing public health crises of our time. Whether it is the rapid rise of prescription opioid addiction or the longstanding challenge of alcohol dependence, substance misuse and substance use disorders can—and do— prevent people from living healthy and productive lives. And, just as importantly, they have profound effects on families, friends, and entire communities.

I recognize there is no single solution. We need more policies and programs that increase access to proven treatment modalities. We need to invest more in expanding the scientific evidence base for prevention, treatment, and recovery. We also need a cultural shift in how we think about addiction. For far too long, too many in our country have viewed addiction as a moral failing. This unfortunate stigma has created an added burden of shame that has made people with substance use disorders less likely to come forward and seek help. It has also made it more challenging to marshal the necessary investments in prevention and treatment. We must help everyone see that addiction is not a character flaw – it is a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.

I am proud to release The Surgeon General’s Report on Alcohol, Drugs, and Health. As the first ever Surgeon General’s Report on this important topic, this Report aims to shift the way our society thinks about substance misuse and substance use disorders while defining actions we can take to prevent and treat these conditions.

Over the past few decades, we have built a robust evidence base on this subject. We now know that there is a neurobiological basis for substance use disorders with potential for both recovery and recurrence. We have evidence-based interventions that prevent harmful substance use and related problems, particularly when started early. We also have proven interventions for treating substance use disorders, often involving a combination of medication, counseling, and social support. Additionally, we have learned that recovery has many pathways that should be tailored to fit the unique cultural values and psychological and behavioral health needs of each individual. As Surgeon General, I care deeply about the health and well-being of all who are affected by substance misuse and substance use disorders.

This Report offers a way forward through a public health approach that is firmly grounded in the best available science. Recognizing that we all have a role to play, the Report contains suggested actions that are intended for parents, families, educators, health care professionals, public policy makers, researchers, and all community members.

Above all, we can never forget that the faces of substance use disorders are real people. They are a beloved family member, a friend, a colleague, and ourselves. Despite the significant work that remains ahead of us, there are reasons to be hopeful. I find hope in the people I have met in recovery all across America who are now helping others with substance use disorders find their way. I draw strength from the communities I have visited that are coming together to work on prevention initiatives and to connect more people to treatment. And I am inspired by the countless family members who have lost loved ones to addiction and who have transformed their pain into a passion for helping others. These individuals and communities are rays of hope. It is now our collective duty to bring such light to all corners of our country.

How we respond to this crisis is a moral test for America. Are we a nation willing to take on an epidemic that is causing great human suffering and economic loss? Are we able to live up to that most fundamental obligation we have as human beings: to care for one another?

Fifty years ago, the landmark Surgeon General’s report on the dangers of smoking began a half century of work to end the tobacco epidemic and saved millions of lives. With The Surgeon General’s Report on Alcohol, Drugs, and Health, I am issuing a new call to action to end the public health crisis of addiction. Please join me in taking the actions outlined in this Report and in helping ensure that all Americans can lead healthy and fulfilling lives.

Vivek H. Murthy, M.D., M.B.A., Vice Admiral, U.S. Public Health Service, Surgeon General

To read The Surgeon General’s Report on Alcohol, Drugs, and Health click on the following link: https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf

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Growth in Self-Control

We come now to the last of the nine fruits of the Spirit, self-control. (See Galatians 5:22-23) The nine Beatitudes (Matthew 5) could be pronounced on those who bear these nine fruits, and there could well be special emphasis on the last in this way: “Blessed are the self-controlled.”

It is interesting that Paul puts self-control last. Most systems, ancient and modern, would put it first. Confucianism through self-control would strive to produce “the superior man;” Hunduism through breath- and thought-control would try to produce “the realized man;” Stoicism through will-control desires to produce “the happy man.” The Christian way produces through Christ-control the self-controlled man. But note that self-control is not so much a means as an end. You do not gain Christ through self-control; you gain self-control through Christ.

The love of Christ constrains us, or, literally, “narrows us to His way.” If you begin with self-control, then you are the center, you are controlling yourself. And you will be anxious lest you slip out from beneath your control. I can think of very few situations in which this illusion of self-control is more prevalent than with the addict or alcoholic. There is always this insanely persistent illusion that you’ve “got this handled.”

If you begin, as Paul does here, with love, then the spring of action is love for a Person, someone outside of yourself. You are released from yourself and from self-preoccupation. The power of a new affection breaks the tyranny of self-love and releases your powers. This means that you are a relaxed and, therefore, a released person. When you begin with love, you end in self-control. But it is not a nervous, anxious, tied-up self control; it is a control that is natural and unrestrained, therefore beautiful.

Self-control, the last fruit of the Spirit, is the one that makes all the rest operative. To the Greek, self-control meant to have power over oneself. Paul grasped this quality from the four cardinal virtues of the Stoics, and claimed it as one of the many vital aspects of the Holy Spirit. The Greek word egkrateia means to have strength to control the self. We know this is not possible until we surrender to Christ’s management.

This sublime fruit of the Spirit is not negative. It does not delineate what we are against or will not do. Rather, it consists of a very positive capacity to know who we are and what we will do because the Spirit is in control of our abilities and aptitudes, as well as our appetites. We can have power over ourselves only when we have submitted to the Spirit’s control and power in us. Christ’s control is the basis of self-control.

The fruit of Christ’s indwelling is more than just not flying off the handle or always being Mr. Perfect or Ms. Smooth. Instead, it’s being centered so that all our energies, when multiplied by the Spirit, can be used creatively rather than be squandered. A person who has the fruit of self-control becomes like a wind channel in which the power of the wind is directed. It is silent strength that’s focused to do what the Master commands.

Interestingly enough, this is the only place where the word self-control (egkrateia) is used in the New Testament. And here it is used last as a by-product of love for Christ. Love Christ and do as you like, for you’ll like what He likes.

Governor Tom Wolf Signs Opioid Bills Into Law

Gov. Tom Wolf signed into law a package of legislation meant to curb addiction to prescription painkillers and heroin in a state that saw more than 3,500 people die last year of drug overdose. New laws mandate seven-day limits on painkiller prescriptions like oxycodone for both minors and emergency room patients who are treated and released.

Legislation also establishes curriculum on safe prescribing for medical school students and professionals seeking license renewal, boosts the frequency prescription drug prescribers and dispensers utilize and update the Pennsylvania Prescription Drug Monitoring Program (PDMP), and widely expands potential drop-off locations for unused prescription drugs. The move came five weeks after a rare joint meeting of the state House of Representatives and Senate at which Wolf called for action addressing the opioid and heroin addiction crisis as the end drew near in the 2015-2016 legislative session.

Last week, the General Assembly adopted the bills

Governor Wolf said, “I am proud to sign a package of bills that represents the work that we have all done together to address the heroin and opioid abuse crisis and begins to curb the effects of this public health epidemic in Pennsylvania.” State Senator  Gen Yaw (R) of Williamsport, PA was the prime sponsor of two of the bills. He compared the Legislature’s work to the strength of a rope. Each bill represents a single strand. “Alone, they might not be fully effective, but together, they can strengthen the rope and our collective efforts.” He said he appreciates the support of the legislative leadership, and remarked that he is thankful for the governor’s prompt signing of the bills into law.

Glenda Bonetti, director of Northumberland County’s Drug and Alcohol Program, fully supports the prescribing limits. She estimates the average age of first-time opioid users who seek help through her office as 17. In her experience, many who become addicted tend to progress to heroin. Bonetti is grateful for the legislative action, but said it took opioid abuse to become prevalent in the middle and upper classes to get noticed. She said, “The reason it’s becoming more publicized is because it’s not just the impoverished who are affected. It’s affecting wealthy families, not just poor people.”

– by Eric Scicchitano, The Daily Item, November 3, 2016

The Secret of Self-Control

Here was a man who had spent two hundred hours in trying to help an alcoholic get control of himself. Then the alcoholic decided to get on his knees, surrender to Christ, and let Christ control him. He got up from his knees a free man. He never touched alcohol again. He found self-control through Christ-control.

I tried the Christian life as self-control. Every day I would start out with the thought and purpose that I would keep myself from sin that day. And every night I came back a failure. For how could an uncontrolled will control an uncontrolled self? A diseased will could not heal a diseased soul.  Then Christ moved into the affections. I began to love Him. Then the lesser loves dropped away.

Professor Royce, in his philosophy of “Loyalty,” says, “There is only one way to be an ethical individual, and that is to choose your cause and then serve it.” This central loyalty to a cause puts other loyalties in their places as subordinate. Then life as a whole is coordinated, since the lesser loyalties are subordinated. To the Christian the “cause” is Christ and His Kingdom. We seek these first, and then all other things, including self-control, are added.

But not automatically. We have to cooperate. We have to throw our wills on the side of being disciplined. There are many who throw their wills on the other side – indiscipline, sometimes called freedom. A junior-high-school girl had on her belt this declaration of wants: “We want more holidays, less homework, more TV, and later hours for bedtime.” Her crowd wanted to be free to do as they liked, not to be free to do as they ought. The result is inward and outward chaos. People who try to be free through indiscipline are “free in the sense that a ship is free when it has lost both compass and rudder. “The undisciplined  person may sit at a piano,” says Trueblood, “but he is not free to strike the notes he would like to strike. He is not free because he has not paid the necessary price for that particular freedom.” Freedom is the byproduct  of a disciplined person. Then you are not merely “free from;” you are “free to.”

Heavenly father, help me to be the kind of person who is “free to” – free to do the very highest I am capable of doing.Amen.

– E. Stanley Jones

The Summer Day

I know. It’s Fall. Tomorrow is Election Day. So I stand accused of trying to prolong the warmth of the unfettered sun for just a bit longer. I give you Mary Oliver.

Who made the world?
Who made the swan, and the black bear?
Who made the grasshopper?
This grasshopper, I mean –
the one who has flung herself out of the grass,
the one who is eating sugar out of my hand,
who is moving her jaws back and forth instead of up and down –
who is gazing around with her enormous and complicated eyes.
Now she lifts her pale forearms and thoroughly washes her face.
Now she snaps her wings open, and floats away.
I don’t know exactly what prayer is.
I do know how to pay attention, how to fall down
into the grass, kneel down in the grass,
how to be idle and blessed, how to stroll through the fields,
which is what I have been doing all day.
Tell me, what else should I have done?
Doesn’t everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?